|
AEROMINI TRACHOBRONCH STENT 8*
|
Facility
|
IP
|
$11,877.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,544.08 |
| Max. Negotiated Rate |
$11,402.40 |
| Rate for Payer: Aetna Commercial |
$9,145.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,264.45
|
| Rate for Payer: Cash Price |
$5,938.75
|
| Rate for Payer: Cigna Commercial |
$9,858.32
|
| Rate for Payer: First Health Commercial |
$11,283.62
|
| Rate for Payer: Humana Commercial |
$10,095.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,739.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,765.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,563.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,452.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,908.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,682.02
|
| Rate for Payer: PHCS Commercial |
$11,402.40
|
| Rate for Payer: United Healthcare All Payer |
$10,452.20
|
|
|
AEROMINI TRACHOBRONCH STENT 8*
|
Facility
|
OP
|
$11,877.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,544.08 |
| Max. Negotiated Rate |
$11,402.40 |
| Rate for Payer: Aetna Commercial |
$9,145.68
|
| Rate for Payer: Anthem Medicaid |
$4,084.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,264.45
|
| Rate for Payer: Cash Price |
$5,938.75
|
| Rate for Payer: Cigna Commercial |
$9,858.32
|
| Rate for Payer: First Health Commercial |
$11,283.62
|
| Rate for Payer: Humana Commercial |
$10,095.88
|
| Rate for Payer: Humana KY Medicaid |
$4,084.67
|
| Rate for Payer: Kentucky WC Medicaid |
$4,126.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,739.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,765.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,563.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,166.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,452.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,908.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,682.02
|
| Rate for Payer: PHCS Commercial |
$11,402.40
|
| Rate for Payer: United Healthcare All Payer |
$10,452.20
|
|
|
AEROMINI TRCHOBRNC STENT 10*10
|
Facility
|
IP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
AEROMINI TRCHOBRNC STENT 10*10
|
Facility
|
OP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem Medicaid |
$4,398.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Humana KY Medicaid |
$4,398.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,443.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,486.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
AEROMINI TRCHOBRNC STENT 10*15
|
Facility
|
OP
|
$11,877.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,544.08 |
| Max. Negotiated Rate |
$11,402.40 |
| Rate for Payer: Aetna Commercial |
$9,145.68
|
| Rate for Payer: Anthem Medicaid |
$4,084.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,264.45
|
| Rate for Payer: Cash Price |
$5,938.75
|
| Rate for Payer: Cigna Commercial |
$9,858.32
|
| Rate for Payer: First Health Commercial |
$11,283.62
|
| Rate for Payer: Humana Commercial |
$10,095.88
|
| Rate for Payer: Humana KY Medicaid |
$4,084.67
|
| Rate for Payer: Kentucky WC Medicaid |
$4,126.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,739.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,765.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,563.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,166.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,452.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,908.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,682.02
|
| Rate for Payer: PHCS Commercial |
$11,402.40
|
| Rate for Payer: United Healthcare All Payer |
$10,452.20
|
|
|
AEROMINI TRCHOBRNC STENT 10*15
|
Facility
|
IP
|
$11,877.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,544.08 |
| Max. Negotiated Rate |
$11,402.40 |
| Rate for Payer: Aetna Commercial |
$9,145.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,264.45
|
| Rate for Payer: Cash Price |
$5,938.75
|
| Rate for Payer: Cigna Commercial |
$9,858.32
|
| Rate for Payer: First Health Commercial |
$11,283.62
|
| Rate for Payer: Humana Commercial |
$10,095.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,739.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,765.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,563.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,452.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,908.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,682.02
|
| Rate for Payer: PHCS Commercial |
$11,402.40
|
| Rate for Payer: United Healthcare All Payer |
$10,452.20
|
|
|
AEROMINI TRCHOBRNC STENT 12*10
|
Facility
|
IP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
AEROMINI TRCHOBRNC STENT 12*10
|
Facility
|
OP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem Medicaid |
$4,398.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Humana KY Medicaid |
$4,398.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,443.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,486.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
AEROMINI TRCHOBRNC STENT 12*15
|
Facility
|
OP
|
$11,877.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,544.08 |
| Max. Negotiated Rate |
$11,402.40 |
| Rate for Payer: Aetna Commercial |
$9,145.68
|
| Rate for Payer: Anthem Medicaid |
$4,084.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,264.45
|
| Rate for Payer: Cash Price |
$5,938.75
|
| Rate for Payer: Cigna Commercial |
$9,858.32
|
| Rate for Payer: First Health Commercial |
$11,283.62
|
| Rate for Payer: Humana Commercial |
$10,095.88
|
| Rate for Payer: Humana KY Medicaid |
$4,084.67
|
| Rate for Payer: Kentucky WC Medicaid |
$4,126.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,739.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,765.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,563.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,166.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,452.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,908.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,682.02
|
| Rate for Payer: PHCS Commercial |
$11,402.40
|
| Rate for Payer: United Healthcare All Payer |
$10,452.20
|
|
|
AEROMINI TRCHOBRNC STENT 12*15
|
Facility
|
IP
|
$11,877.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,544.08 |
| Max. Negotiated Rate |
$11,402.40 |
| Rate for Payer: Aetna Commercial |
$9,145.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,264.45
|
| Rate for Payer: Cash Price |
$5,938.75
|
| Rate for Payer: Cigna Commercial |
$9,858.32
|
| Rate for Payer: First Health Commercial |
$11,283.62
|
| Rate for Payer: Humana Commercial |
$10,095.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,739.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,765.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,563.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,452.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,908.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,682.02
|
| Rate for Payer: PHCS Commercial |
$11,402.40
|
| Rate for Payer: United Healthcare All Payer |
$10,452.20
|
|
|
AEROMINI TRCHOBRNC STENT 14*10
|
Facility
|
IP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
AEROMINI TRCHOBRNC STENT 14*10
|
Facility
|
OP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Anthem Medicaid |
$4,398.48
|
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Humana KY Medicaid |
$4,398.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,443.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,486.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
AEROMINI TRCHOBRNC STENT 14*15
|
Facility
|
IP
|
$11,877.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,544.08 |
| Max. Negotiated Rate |
$11,402.40 |
| Rate for Payer: Aetna Commercial |
$9,145.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,264.45
|
| Rate for Payer: Cash Price |
$5,938.75
|
| Rate for Payer: Cigna Commercial |
$9,858.32
|
| Rate for Payer: First Health Commercial |
$11,283.62
|
| Rate for Payer: Humana Commercial |
$10,095.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,739.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,765.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,563.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,452.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,908.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,682.02
|
| Rate for Payer: PHCS Commercial |
$11,402.40
|
| Rate for Payer: United Healthcare All Payer |
$10,452.20
|
|
|
AEROMINI TRCHOBRNC STENT 14*15
|
Facility
|
OP
|
$11,877.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,544.08 |
| Max. Negotiated Rate |
$11,402.40 |
| Rate for Payer: Aetna Commercial |
$9,145.68
|
| Rate for Payer: Anthem Medicaid |
$4,084.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,264.45
|
| Rate for Payer: Cash Price |
$5,938.75
|
| Rate for Payer: Cigna Commercial |
$9,858.32
|
| Rate for Payer: First Health Commercial |
$11,283.62
|
| Rate for Payer: Humana Commercial |
$10,095.88
|
| Rate for Payer: Humana KY Medicaid |
$4,084.67
|
| Rate for Payer: Kentucky WC Medicaid |
$4,126.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,739.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,765.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,563.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,166.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,452.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,908.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,682.02
|
| Rate for Payer: PHCS Commercial |
$11,402.40
|
| Rate for Payer: United Healthcare All Payer |
$10,452.20
|
|
|
AEROMINI TRCHOBRNC STENT 8*10
|
Facility
|
OP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem Medicaid |
$4,398.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Humana KY Medicaid |
$4,398.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,443.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,486.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
AEROMINI TRCHOBRNC STENT 8*10
|
Facility
|
IP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
AEROSOL VENT/PERF LUNG SCAN
|
Professional
|
Both
|
$2,479.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
34000025
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$56.23 |
| Max. Negotiated Rate |
$2,479.00 |
| Rate for Payer: Anthem Medicaid |
$247.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,479.00
|
| Rate for Payer: Cash Price |
$1,239.50
|
| Rate for Payer: Cash Price |
$1,239.50
|
| Rate for Payer: Cigna Commercial |
$526.39
|
| Rate for Payer: Healthspan PPO |
$349.79
|
| Rate for Payer: Humana Medicaid |
$247.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$252.04
|
| Rate for Payer: Molina Healthcare Passport |
$247.10
|
| Rate for Payer: Multiplan PHCS |
$1,487.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,735.30
|
| Rate for Payer: UHCCP Medicaid |
$867.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$249.57
|
|
|
AEROSOL VENT/PERF LUNG SCAN
|
Facility
|
IP
|
$2,479.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
34000025
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$322.27 |
| Max. Negotiated Rate |
$2,379.84 |
| Rate for Payer: Aetna Commercial |
$1,908.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,933.62
|
| Rate for Payer: Cash Price |
$1,239.50
|
| Rate for Payer: Cigna Commercial |
$2,057.57
|
| Rate for Payer: First Health Commercial |
$2,355.05
|
| Rate for Payer: Humana Commercial |
$2,107.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,032.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,829.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$743.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,181.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,859.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$495.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$322.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$768.49
|
| Rate for Payer: PHCS Commercial |
$2,379.84
|
| Rate for Payer: United Healthcare All Payer |
$2,181.52
|
|
|
AEROSOL VENT/PERF LUNG SCAN
|
Facility
|
OP
|
$2,479.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
34000025
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$322.27 |
| Max. Negotiated Rate |
$2,379.84 |
| Rate for Payer: Aetna Commercial |
$1,908.83
|
| Rate for Payer: Anthem Medicaid |
$852.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$467.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,933.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$654.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$630.99
|
| Rate for Payer: Cash Price |
$1,239.50
|
| Rate for Payer: Cash Price |
$1,239.50
|
| Rate for Payer: Cigna Commercial |
$2,057.57
|
| Rate for Payer: First Health Commercial |
$2,355.05
|
| Rate for Payer: Humana Commercial |
$2,107.15
|
| Rate for Payer: Humana KY Medicaid |
$852.53
|
| Rate for Payer: Humana Medicare Advantage |
$467.40
|
| Rate for Payer: Kentucky WC Medicaid |
$861.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,032.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,829.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$869.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,181.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,859.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$495.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$322.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$768.49
|
| Rate for Payer: PHCS Commercial |
$2,379.84
|
| Rate for Payer: United Healthcare All Payer |
$2,181.52
|
|
|
AEROSOL VENT/PERF LUNG SCAN(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
340P0025
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$526.39 |
| Rate for Payer: Anthem Medicaid |
$247.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$526.39
|
| Rate for Payer: Healthspan PPO |
$349.79
|
| Rate for Payer: Humana Medicaid |
$247.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$252.04
|
| Rate for Payer: Molina Healthcare Passport |
$247.10
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$249.57
|
|
|
AEROSOL VENT/PERF LUNG SCAN(T
|
Facility
|
IP
|
$2,329.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
340T0025
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$302.77 |
| Max. Negotiated Rate |
$2,235.84 |
| Rate for Payer: Aetna Commercial |
$1,793.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,816.62
|
| Rate for Payer: Cash Price |
$1,164.50
|
| Rate for Payer: Cigna Commercial |
$1,933.07
|
| Rate for Payer: First Health Commercial |
$2,212.55
|
| Rate for Payer: Humana Commercial |
$1,979.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,909.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,718.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$698.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,049.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,746.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$465.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$721.99
|
| Rate for Payer: PHCS Commercial |
$2,235.84
|
| Rate for Payer: United Healthcare All Payer |
$2,049.52
|
|
|
AEROSOL VENT/PERF LUNG SCAN(T
|
Facility
|
OP
|
$2,329.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
340T0025
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$302.77 |
| Max. Negotiated Rate |
$2,235.84 |
| Rate for Payer: Aetna Commercial |
$1,793.33
|
| Rate for Payer: Anthem Medicaid |
$800.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$467.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,816.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$654.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$630.99
|
| Rate for Payer: Cash Price |
$1,164.50
|
| Rate for Payer: Cash Price |
$1,164.50
|
| Rate for Payer: Cigna Commercial |
$1,933.07
|
| Rate for Payer: First Health Commercial |
$2,212.55
|
| Rate for Payer: Humana Commercial |
$1,979.65
|
| Rate for Payer: Humana KY Medicaid |
$800.94
|
| Rate for Payer: Humana Medicare Advantage |
$467.40
|
| Rate for Payer: Kentucky WC Medicaid |
$809.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,909.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,718.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$817.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,049.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,746.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$465.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$721.99
|
| Rate for Payer: PHCS Commercial |
$2,235.84
|
| Rate for Payer: United Healthcare All Payer |
$2,049.52
|
|
|
AERO TRACHBRONCHIAL STENT 16*4
|
Facility
|
OP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem Medicaid |
$3,645.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Humana KY Medicaid |
$3,645.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,682.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,718.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
AERO TRACHBRONCHIAL STENT 16*4
|
Facility
|
IP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
AERO TRACHEOBRONCH STENT 10*20
|
Facility
|
OP
|
$11,695.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.35 |
| Max. Negotiated Rate |
$11,227.20 |
| Rate for Payer: Aetna Commercial |
$9,005.15
|
| Rate for Payer: Anthem Medicaid |
$4,021.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.10
|
| Rate for Payer: Cash Price |
$5,847.50
|
| Rate for Payer: Cigna Commercial |
$9,706.85
|
| Rate for Payer: First Health Commercial |
$11,110.25
|
| Rate for Payer: Humana Commercial |
$9,940.75
|
| Rate for Payer: Humana KY Medicaid |
$4,021.91
|
| Rate for Payer: Kentucky WC Medicaid |
$4,062.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,102.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,339.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,520.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,625.45
|
| Rate for Payer: PHCS Commercial |
$11,227.20
|
| Rate for Payer: United Healthcare All Payer |
$10,291.60
|
|
